M.A. Coelho Neto

True Reproducibility of UltraSound Techniques (TRUST): systematic review of reliability studies in obstetrics and gynecology

To examine the quality of methods used and the accuracy of the interpretation of agreement in existing studies that examine the reliability of ultrasound measurements and judgments in obstetrics and gynecology.

Ultrasound guidance during embryo transfer: a systematic review and meta-analysis of randomized controlled trials

To summarize the current evidence on the effect of using ultrasound (US) guidance during embryo transfer (ET).

Time‐lapse embryo imaging for improving reproductive outcomes: systematic review and meta‐analysis

To identify, appraise and summarize the available evidence regarding the effectiveness and safety of time‐lapse embryo monitoring on the main outcomes of assisted reproductive techniques.

Assessment of ovarian reserve by antral follicle count in ovaries with endometrioma

To evaluate whether the antral follicle count (AFC) is underestimated in the presence of an endometrioma.

Ovarian response is a better predictor of clinical pregnancy rate following embryo transfer than is thin endometrium or presence of an endometrioma

To examine whether endometrial thickness and the presence of endometrioma are independent predictors of clinical pregnancy rate or simply associated with poor ovarian response (POR).

Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between normal/arcuate and septate uterus?

To assess the level of agreement between experts in distinguishing between septate and normal/arcuate uterus using their subjective judgment when reviewing the coronal view of the uterus from three‐dimensional ultrasound. Another aim was to determine the interobserver reliability and diagnostic test accuracy of three measurements suggested by recent guidelines, using as reference standard the decision made most often by experts (Congenital Uterine Malformation by Experts (CUME)).

Counting ovarian antral follicles by ultrasound: a practical guide

This Consensus Opinion summarizes the main aspects of several techniques for performing ovarian antral follicle count (AFC), proposes a standardized report and provides recommendations for future research. AFC should be performed using a transvaginal ultrasound (US) probe with frequency ≥ 7 MHz. For training, we suggest a minimum of 20–40 supervised examinations. The operator should be able to adjust the machine settings in order to achieve the best contrast between follicular fluid and ovarian stroma. AFC may be evaluated using real‐time two‐dimensional (2D) US, stored 2D‐US cine‐loops and stored three‐dimensional (3D) US datasets. Real‐time 2D‐US has the advantage of permitting additional maneuvers to determine whether an anechoic structure is a follicle, but may require a longer scanning time, particularly when there is a large number of follicles, resulting in more discomfort to the patient. 2D‐US cine‐loops have the advantages of reduced scanning time and the possibility for other observers to perform the count. The 3D‐US technique requires US machines with 3D capability and the operators to receive additional training for acquisition/analysis, but has the same advantages as cine‐loop and also allows application of different imaging techniques, such as volume contrast imaging, inversion mode and semi‐automated techniques such as sonography‐based automated volume calculation. In this Consensus Opinion, we make certain recommendations based on the available evidence. However, there is no strong evidence that any one method is better than another; the operator should choose the best method for counting ovarian follicles based on availability of resources and on their own preference and skill. More studies evaluating how to improve the reliability of AFC should be encouraged. Copyright

EP27.11: Normal/arcuate vs septate uterus: interobserver reliability/agreement of currently used measurements

withdrawn EP27.11 Normal/arcuate vs septate uterus: interobserver reliability/agreement of currently used measurements A. Ludwin2,9, W.P. Martins5,4, C.O. Nastri4,5, I. Ludwin2,9, M.A. Coelho Neto4, V. Leitão4, M. Acién10, J. Alcazar8, B.R. Benacerraf3, G. Condous1, R.L. De Wilde17, M.H. Emanuel6, W.E. Gibbons11, S. Guerriero7, W.W. Hurd12, D. Levine13, S. Lindheim14, A. Pellicer15, F. Petraglia15, E. Saridogan16 1Obstetrics and Gynecology, Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia; 2Department of Gynecology and Oncology, Chair of Gynecology and Obstetrics of Jagiellonian University, Krakow, Poland; 3Harvard Medical School, Brookline, MA, USA; 4Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil; 5Reproductive Medicine, SEMEAR fertilidade, Ribeirao Preto, São Paulo, Brazil; 6Obstetrics and Gynecology, Spaarne Hospital, Hoofddorp, Netherlands; 7Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy; 8Obstetrics and Gynecology, University of Navarra, Pamplona, Spain; 9Ludwin and Ludwin Gynecology, Krakow, Poland; 10San Juan University Hospital/Miguel Hernández University, Alicante, Spain; 11Baylor College of Medicine, Houston, TX, USA; 12Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Duke University Medical Centre, Durham, NC, USA; 13Beth Israel Deaconess Medical Centre, Boston, MA, USA; 14Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA; 15Instituto Valenciano de Infertilidad, Krakow, Spain; 16University College London Hospital, London, United Kingdom; 17Carl-von-Ossietzky-University Oldenburg, Oldenburg, Germany Objectives: To evaluate the inter-observer reliability/agreement of currently used measurements to distinguish between normal/arcuate and septate uterus. Methods: We included 100 women evaluated between Jun-2016 and Jul-2016 with suspected uterine anomaly, using a single 3D data-set of each uterus. Two observers using the same initial data-set, independently manipulated the uterus to obtain the coronal plane and performed the following measurements blinded to each other results: indentation depth, indentation angle, and uterine fundal wall thickness; the latter was used to calculated the indentation to wall thickness (I:WT) ratio. Inter-observer reliability and agreement of indentation depth, angle and I: WT ratio were assessed by concordance correlation coefficient (CCC) and limits of agreement (LoA). Results: The inter-rater reliability of indentation depth (CCC=0.99, 95%CI=0.98-0.99) was significantly better than both indentation angle (CCC=0.96, 95%CI=0.94-0.97) and I:WT ratio (CCC=0.92, 95%CI=0.90-0.94). The LoA were: indentation depth = -1.7mm to +2.1mm; indentation angle = -17◦ to +16◦; and I:WT ratio = -75% to + 96%. Conclusions: Among the three measurements frequently used to distinguish between normal/arcuate and septate uterus, the indentation depth was the most reliable; differences up to ± 2mm are expected if the measurement is repeated by another observer. EP27.12 Abstract withdrawn EP28: BLEEDING, ENDOMETRIAL AND MYOMETRIAL PATHOLOGY EP28.01 Uterine artery pseudoaneurysm with coexisting artrovenous malformation F. Buonomo1, R. Federico1, R. De Leo2, M. Mirandola1, T. Stampalija1, G. Ricci1 1Institute of Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy; 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy A 33-year old woman with a massive uterine bleeding occurred after a LPS treated uterine rupture due to a miomectomy scar pregnancy. US revealed an anechoic intramiometrial lesion surrounded by multiple tubular anechoic lesions distributed in the myometrium. 2D US and Colour Doppler sonography revealed a central arterial-like turbulent, low impedance blood flow inside the lesion. The hypothesis was of a uterine artery pseudoaneusysm and coexisting AV malformation. A 3DTVUS was performed to evaluate the exact position of the lesion and its angioarchitecture. The HD-flow 3D reconstruction of the resulting image revealed a large right pseudoaneurysm vascularised by an ecstatic vessel originated by the right uterine artery. Right artery embolisation was performed. 3D HD flow Doppler evaluation four days later showed persistent blood flow deriving from a collateral left uterine artery vessel. The patient was led to left uterine artery embolisation as well. 3D reconstruction of colour/Power Doppler sonographic images can enable us to understand the spatial relationship of vessels in areas where complex structures are present. 3D-US can provide additional information useful to clinicians such as identification of the vascular connections including its feeding and draining vessel. The present case emphasises the importance of ultrasound investigation, in the management of vascular pathologies, initially with 2D grey and subsequently with Colour Doppler and 3D, both in terms of diagnostic approach of vascular defects as well as of follow up in order to assess the persistence of a turbulent flow after invasive procedures such as artery embolisation. Supporting information can be found in the online version of this abstract

P26.10: Normal/arcuate vs septate uterus: agreement among experts' subjective impression evaluating the coronal plane of the uterus on 3D ultrasound

using HDlive. The four images for each uterus were combined in a single image, and the 100 combined images (one for each uterus) were anonymised and submitted to 15 experts (5 clinicians, 5 surgeons and 5 sonologists). These experts were asked to judge the image quality of each imaging technique using an 11-point numeric scale (0-10), providing only one vote for each imaging technique. Results were summarised as median and interquartile range (IQR), and comparison across groups performed with Friedman test. Results: Considering the opinion of all fifteen experts, only MP was considered as providing significantly worse imaging quality: MP=7(6-9), VCI=8(8-10), Omniview=8(8-9), and HDlive=9(8-10); p=0.002. Considering only the five clinicians the results were: MP=7(5-9.5), VCI=8(7.5-9.5), Omniview=8(7.5-9.5), and HDlive=8(8-9.5; p=0.39). Considering only the five surgeons, the results were: MP=7(5-9.5), VCI=8(7.5-9.5), Omniview=8(7.5-9.5), and HDlive=8(8-9.5). Considering only the five sonologists, the results were: MP=7(6-8.5), VCI=8(7.5-10), Omniview=9(8.5-9.5), and HDlive=10(9-10). Conclusions: Experts showed a preference for rendered imaging techniques when assessing the coronal plane of the uterus.

P26.09: Image quality of the coronal plane of the uterus by 3D ultrasound: comparison of four techniques based on the opinion of several experts

female offspring of PCOS women already show higher androgen levels compared to the female offspring of non-PCOS women. Methods: Androgen levels were determined in maternal serum and umbilical cord blood from PCOS and non-PCOS women and the respective offspring at the Medical University of Graz, Austria, between 2012 and 2015. Results: A total of 79 PCOS and 354 non-PCOS women were recruited. The main results are shown in table 1. Conclusions: The comparison revealed that androgen levels in female offspring of PCOS and non-PCOS women do not differ although maternal hormone levels differ significantly.